Provider Demographics
NPI:1497366926
Name:MCCLUNG, KAILIN (PA)
Entity Type:Individual
Prefix:
First Name:KAILIN
Middle Name:
Last Name:MCCLUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4130 PIONEER WOODS DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7552
Mailing Address - Country:US
Mailing Address - Phone:402-489-4700
Mailing Address - Fax:402-429-5220
Practice Address - Street 1:4130 PIONEER WOODS DR STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7552
Practice Address - Country:US
Practice Address - Phone:402-489-4700
Practice Address - Fax:402-489-5220
Is Sole Proprietor?:No
Enumeration Date:2020-08-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2516363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant